LOS ANGELES - Reaching minorities with essential medical services
Most American women take health screenings for granted: Pap smears and mammograms are a routine, though vital, part of their lives. But in many cases, women in minority groups have little or no access to these life-saving preventive services. A new community-based program, sponsored by CDC, the CDC Foundation, and The California Endowment, is designed as a model for educating these hard-to-reach groups. Called Promoting Access to Health (PATH), the program aims to increase breast and cervical cancer screenings among Southeast Asian and Pacific Islander women in Los Angeles and Orange County, California.
“Imagine yourself as an immigrant or a refugee with no medical insurance,” says Mary Anne Foo, principal investigator with Special Service for Groups - the organization helping to implement the project at the local level. “You work in an hourly job with no sick leave, and you face a hard choice: feeding your family or leaving work to get an exam.
“You speak Cambodian, Laotian, Thai, Vietnamese, Chamorro, Samoan, or Tongan - but not English. Never in your life have you had a breast or pelvic exam. Such ‘intrusions’ may even be taboo in your culture. There are public health officials who want to help you, but the barriers of income, language, culture, and fear seem insurmountable.”
PATH uses innovative approaches to breach these barriers. A mobile mammography van visits temples during the Thai New Year. A Cambodian singer infuses prevention messages into her songs. Special “patient navigators” are trained to help the women make doctors appointments, interpret results, answer questions, and ensure follow-up.
“Using local strategies is the key to success,” says Letitia Presley-Cantrell, chief of the Community Health Section of CDC’s Division of Adult & Community Health. “You go in and ask the question, ‘What things are you doing in your community that work?’ That’s one reason partnerships are so important.”
PATH is a component of REACH 2010 (Racial and Ethnic Approaches to Community Health), a national demonstration project established by CDC to address disparities in public health: maternal, infant, and child health; diabetes; heart disease and stroke; HIV; immunization and infectious disease; and cancer. In support of its work to address disparities in health, The California Endowment joined the effort in September 1999 and has granted more than $10 million to the CDC Foundation to support REACH programs in California.
“Working through community organizations creates the most effective change,” says Robert K. Ross, M.D., president and CEO of The California Endowment. “The CDC Foundation was instrumental in bringing together this partnership between The California Endowment, CDC, and Special Service for Groups. We are enthusiastic about helping CDC make an impact within California’s diverse communities.”
“In supporting this project, The California Endowment is extending the scope of REACH in California,” says Presley-Cantrell. “Their funding allows us to add communities to the program that otherwise would not have been funded. What you have here is regional funding support for a national program, which is unique.”
She believes the benefits of the partnership will stretch far beyond California. “PATH will add to the wealth of information CDC is collecting through the REACH program nationally,” she says. “We are learning, firsthand, the best ways to bring preventive medicine to minority communities.”
Mary Anne Foo notes, “We will never eliminate the disparity in health care unless we all come together. What’s exciting to me is that this program is truly elevating the effort. I believe we can change public health from the inside out.”